Delivering High Value Care Through Clinical Integration

1. Delivering High Value Care Through Clinical Integration www.TriadHealthCareNetwork.com

2. Triad HealthCare NetworkOverview • Triad HealthCare Network is a new Clinically Integrated Network that has formed in the Piedmont Triad area. • THN is a new model of care designed to bring employed physicians, independent physicians, and Cone Health into a more clinically and financially aligned business partnership to improve access, improve quality and lower costs. • THN seeks to better prepare its members for the inevitable changes to the nation’s health care system driven by either or both government and market-based reform. www.TriadHealthCareNetwork.com

3. Triad HealthCare NetworkStructure and Governance Management Executive Medical Director Thomas Wall, M.D. Executive Director Steve Neorr 8 members: 3 Physicians (2 Ind./1 Emp.) 2 Cone Representatives 3 Community Representatives Board of Managers Assist development of physician board memberships Nominating Committee 21 members: 17 Physicians (9 Ind./8 Emp.) 3 Cone Representatives 1 Community Representative Operating Committee Oversees day-to-day operations Contracting and Finance Committee Credentialing Committee Quality Look at 3rd-party agreements and determine potential bonus distributions Set clinical performance criteria and review member performance Initial and ongoing membership criteria www.TriadHealthCareNetwork.com

4. Triad HealthCare NetworkProposed Quality Committee Structure Quality Committee Patrick Wright, M.D. – Chairman Mary Jo Cagle, M.D. – Vice Chairman Heart and Vascular CPC Ed Gerhardt, MD Tom Stuckey, MD Primary Care CPC Doug Shaw, MD Yvonne Lowne, DO Women’s and Children’s CPC Kelly Leggett, MD Ron Young, MD Medicine CPC Carl Gessner, MD John Bednar, MD Surgery CPC David Newman, MD John Hewitt, MD Hospital Clinical Services CPC Josh Kish, MD Mark Shogry, MD Practice Management John Nosek TBD Administrative Chair Administrative Chair Administrative Chair Administrative Chair Administrative Chair Administrative Chair Administrative Chair Ob/Gyn Cardiology Anesthesia Pathology Family Medicine Gastroenterology Community Practice Administrators Neonatology Cardiovascular Surg. General Surgery Radiology Internal Medicine Hem/Oncology Pediatrics Vascular Surgery Orthopedics Radiation Oncology Hospital Medicine Infectious Disease Ophthalmology Nephrology Psychiatry ENT Rheumatology Administrative Chairs would be composed of Cone Health System employees or non-physician health leaders – Hospital presidents, vice presidents, directors of nursing, practice administrators, etc. Urology Dermatology Emergency Medicine Neurosurgery Endocrinology Hospital Medicine Pulmonology Hospice /Palliative Care Neurology www.TriadHealthCareNetwork.com

5. Value for Physicians • THN to provide value-added services and resources to assist practices • Deployment of Clinical Performance Reporting System to: • Capture and analyze clinical data • Implement in-office Point-of-Care decision support • Generate patient disease registries • Case Management • Assistance to achieve Meaningful Use and Patient-Centered Medical Home recognition • Submission of quality measures for the Physician Quality Reporting System (PQRS) • Joint contracting for quality/cost savings incentive plans with payers www.TriadHealthCareNetwork.com

6. Triad HealthCare NetworkBusiness Strategy Insurers and Employers GainSharing Shared Savings P4P Negotiated Incentive-BasedContracts QualityBonus PayoutBased On THN Goals and Performance Measures Continue CurrentFee-For-ServiceClaims & PaymentStructure Clinical Performance Reporting System POC, Registry, Performance Data Claims and EMR Data Physicians www.TriadHealthCareNetwork.com

7. Clinical Performance Reporting System is Critical Point-of-Care Decision Support Data from Practice Management Systems • “Real “ time • Patient Summary • Preventive Care & CDM Reminders Clinical Data Repository (“CDR”) Clinical Protocol Engine Data from EMRs Patient Disease Registries Data from Hospitals Practice Performance Feedback Lab data from Reference Labs Web Portal Access and Reporting Data is extracted, aggregated, standardized and stored by a third-party intermediary vendor Data is processed through protocols and algorithms to support clinical metrics and benchmarks established by Physicians Pharmacy data External Reporting • Community • NCQA, BTE • PQRS • Payers Electronic claims data from payers www.TriadHealthCareNetwork.com

8. Sample Clinical Decision Supportat the Point-of-Care Practice Performance Feedback Goals Not Met are highlighted for quick reference and visibility Diagnoses and Meds are prioritized to highlight chronic conditions Targeted reminders for nursing staff allow better leverage of provider time and more efficient workflow Labs, Calculations and Diagnostic Procedures pertinent to the Action Items are displayed for easy reference www.TriadHealthCareNetwork.com

9. Information Technology/Analytics Systems Health Information Exchange (“HIE”) Clinical Performance Reporting System • Expertise in clinical data extraction • Provides clinical protocol engine • Point-of-care reports • Patient disease registries • “Manual” population analytics • Claims data integration • Reports compliance with metrics • Submits PQRS/ACO data to CMS • Expertise in community data aggregation • Provides longitudinal view of patient across community – all pertinent activity over time • Interfaces with EHRs • Master Patient Index (“MPI”) • Provides portal view to all providers • Ability to enter data for non-EMR physicians All Other PCPs and Specialists PCPs with EMRs CPRS HIE Data from Hospitals Specialists w/ EMRs using POC Clinical Data Repository Community Data Repository Pharmacy data Claims Data from Payers Lab data from Reference Labs Radiology Population analytics, utilization, case management module • “Automatic” population analytics - patient stratification • Prospective identification of patient risk – case mgmt targets • Retrospective analytics – utilization and cost efficiency • Admits/1000, hi-tech imaging, ETGs - Episode Treatment Groups • Identify opportunity for savings and improvement • Case Management module – care documentation, communication • Patient portal – patient engagement

10. HIE View www.TriadHealthCareNetwork.com

11. HIE View www.TriadHealthCareNetwork.com

12. Triad HealthCare NetworkMembership Requirements Physician Eligibility Requirements Physician Participation Requirements • Participation Agreement • Clinical Integration Program • Education • Compliance • Quality Assurance • Provide Claims/Clinical Information • All-Contracts Participation • High-speed internet • Actively Used E-mail • Attend Orientation • North Carolina Licensure • Board Certification • DEA License • Liability Insurance • Credentialing Requirements www.TriadHealthCareNetwork.com

13. Opportunities • Medicare Shared Savings Program • Submitted application to participate as an “ACO” with Medicare effective July 1, 2012 • Submitted 170 adult Primary Care Physician network with application – 5 counties – will include over 34,000 beneficiaries • Will seek conversion from opt-in to executed participation agreements for specialists by June 30, 2012 • Must report and meet 33 “quality” metrics to access savings • All major payers interested in discussing arrangement • Cone Health Employee population (12,000+) • Development of THN-based “narrow” network www.TriadHealthCareNetwork.com

14. Triad HealthCare Network Value Practice Performance Feedback Physicians Cone Health Payers Patients FinancialSupport,Resources Commitment,Participation,Leadership PerformanceIncentivePayments Trust,ProactiveInvolvement GIVE Efficiency,Partnership,Mission IncreasedEfficiency,Coordination Transparency,Efficiency,Quality BetterHealthCare GET Physicians Cone Health Payers Patients www.TriadHealthCareNetwork.com

15. Questions? For further information, please visit www.TriadHealthCareNetwork.com or call (855) 4 THN NOW (484-6669) www.TriadHealthCareNetwork.com